How should the infant be positioned during and after feeds to reduce aspiration risk?

• A. Upright or semi-upright during feeds and for a period after feeding to minimize nasal regurgitation.
• B. Lying flat on the back during feeds.
• C. Side-lying with the head elevated during feeding.
• D. Inverted to reduce nasal drainage.

Answer: (A)

Positioning during and after feeds matters because gravity helps prevent milk from flowing back into the airway. Keeping the infant upright or semi-upright while feeding and for a period after feeding helps minimize nasal regurgitation and reflux, which in turn lowers the risk of aspiration. This is especially important for infants with cleft lip/palate, who can have coordination difficulties with sucking, swallowing, and airway protection; staying upright supports safer swallowing and keeps milk away from the nasal passages and airway.

Lying flat on the back removes that protective effect and increases the chance of milk refluxing upward into the throat and nasal cavity. Side-lying with the head elevated is not as consistently protective as an upright position for preventing aspiration, and inverted positions are not appropriate and don’t address nasal drainage risks. Keeping the infant upright for about 20–30 minutes after feeding is a common guideline to further reduce aspiration risk.